by Liz Szabo, USA TODAY

by Liz Szabo, USA TODAY

Electronic cigarettes need to be strongly regulated - and quickly - to prevent another generation of young people from becoming addicted to nicotine, according to the American Heart Association's first policy statement on the products.

In its statement, the heart association pointed to studies suggesting that e-cigarettes, which contain nicotine but no tobacco, could serve as a "gateway" drug to addict young people, who may go on to regular cigarettes or smokeless tobacco. The association pointed to flavors in e-cigarettes, such as bubble gum, arguing that these are intended to attract kids.

"We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers," said Nancy Brown, CEO of the heart association, in a statement.

An April proposal from the Food and Drug Administration would require most e-cigarettes to undergo an agency review. The proposed rules would ban sales of e-cigarettes to minors and require warning labels. Though some health advocates hailed the announcement, others said the FDA didn't go far enough, because it failed to ban flavors.

In its new statement, the heart association calls on the FDA to put the proposed rules - three years in the making - in place before the end of the year.

"Any additional delay of these new regulations will have real, continuing public health consequences," Brown said.

E-cigarette products have grown dramatically in the past decade. There are 466 brands and more than 7,700 flavors on the market, the policy report says.

Use among teens nearly doubled from 2011 to 2012, and nearly 7% of teens have tried them. About 24 million young people have seen e-cigarette marketing, according to a recent paper in the journal Pediatrics.

A new study suggests that e-cigarettes could be luring some kids into nicotine exposure.

More than 263,000 non-smoking kids tried e-cigarettes last year - three times as many as in 2011, according to a study released by the Centers for Disease Control and Prevention Monday. About 44% of non-smoking kids who experimented with e-cigarettes said they intend to smoke regular cigarettes, compared to 22% of kids who had never tried e-cigs, the study found.

"The increasing number of young people who use e-cigarettes should be a concern for parents and the public health community," said the CDC's Rebecca Bunnell, in a statement. The CDC statement notes that evidence suggests that nicotine harms adolescent brain development, causing "lasting deficits in cognitive function."

"Electronic cigarettes should be classified as tobacco products and subject to the same laws and regulations as other tobacco products," said Vince Willmore, spokesman for the Campaign for Tobacco-Free Kids.

Cynthia Cabrera, executive director of the Smoke-Free Alternatives Trade Association, which represents e-cigarette makers, distributors and retailers, says e-cigarettes can reduce the harm from tobacco by helping people quit or smoke less. Willmore said research doesn't clearly show whether e-cigarettes help people to quit or not.

Cabrera argues that e-cigarettes are much safer than tobacco, which has been blamed for killing 20 million Americans in the past 50 years. Though they don't contain many of the harmful chemicals of conventional cigarettes, the FDA found trace amounts of toxic and carcinogenic ingredients in several samples in late 2008 when the e-cigarette market was beginning in the USA.

The FDA's proposal has "the potential to completely obliterate this industry," Cabrera said. "In a couple of generations, we could have everybody off combustible cigarettes. But to do that, this industry has to survive."

The heart association's statement urges communities and states to include e-cigarettes in their smoke-free laws, to avoid "renormalizing" smoking in public places. The policy report notes that celebrities such as Jenny McCarthy appear in e-cigarette ads, just as Hollywood stars once promoted tobacco.

The heart association advises doctors to urge patients to quit smoking but to use nicotine-replacement products approved by the FDA, which have been tested for safety and effectiveness. Doctors shouldn't discourage former smokers from switching to e-cigarettes, if nothing else helps them avoid tobacco, the policy says.